Contact lens papillary conjunctivitis, also known as giant papillary conjunctivitis, occurs in contact lens wearers and is one of the major reasons that contact lens wearers discontinue lens wear. The signs of the condition can range from mild redness of the upper tarsus with few papillae to severe redness with large cobblestone papillae. The condition has been observed with all types of contact lenses i.e. hard or polymethyl methacrylate (PMMA) lens wear, rigid gas permeable lenses, soft lenses and also silicone hydrogel contact lenses. The condition results in acute patient discomfort, intolerance to contact lens wear, itching, mucus discharge, excessive movement of the lens on the eye and deposits on the lens. Often lens wearers are required to reduce the wearing time of lenses to reduce the frequency of symptoms but left unmanaged the condition ultimately leads to drop outs from lens wear. The incidence of the condition is reported to range from 1.0 to 18.0% depending on the type (soft, rigid gas permeable or silicone hydrogel), mode (daily wear or extended wear) and frequency of replacement of lens wear (daily replacement or weekly or monthly).
Contact lens papillary conjunctivitis is considered to be caused by either or both mechanical irritation or inflammatory reaction. The mechanical aetiology is assumed to derive from a combination of a lack of surface lubrication, friction and surface irregularities of the contact lens. Deposits on the lenses can also cause mechanical irritation. The inflammatory reaction or allergic aetiology is usually related to deposits that build up on the lenses, for example the lens wearer's own lipids, proteins, preservatives in the contact lens solutions that build up on the lens, environmental allergens that build up on the lens, and possibly reaction to the lens material. In this condition papillae form on the upper tarsal conjunctiva of the upper eyelid, which cause discomfort due to the sensitive nature of the tissue.
Contact lens papillary conjunctivitis may also be associated with allergic eye disease which encompasses other notable conditions such as allergic conjunctivitis and vernal conjunctivitis. Allergic conjunctivitis is widely prevalent with estimates suggesting that anywhere from 9 to 18% of the population may be affected. The condition is characterised by itching of the eye and subjects may also complain of tearing, redness and burning. The symptoms could be seasonal or constant in nature. Ocular examination is characterised by redness of the conjunctiva and in some instances presence of small papillae on the upper tarsal conjunctiva (raised polygonal structures on the inside of the upper lid giving the tissue a roughened appearance). In the more serious variants of allergic eye disease, vernal conjunctivitis presents as a more severe, chronic condition primarily affecting children and young adults. Symptoms include severe itching, tearing, foreign body sensation, mucus discharge and photophobia. The condition is characterised by redness of the conjunctiva and giant, cobble stone papillary reaction of the upper tarsal conjunctiva. Variants of the condition are characterised by limbal conjunctival involvement and also corneal erosions.
People who get allergic conjunctivitis or vernal conjunctivitis or contact lens papillary conjunctivitis once often become more susceptible to the condition in the future. The onset of these forms of conjunctivitis may be triggered by the wearing of contact lenses, which leads to a strong incentive to stop the use of contact lenses. Although the occurrence of subsequent instances of contact lens papillary conjunctivitis can be reduced by using daily lenses, this is not an ideal solution. Avoiding an initial episode would therefore be desirable.
Existing methods of treatment of both contact lens papillary conjunctivitis and allergic eye disease using eye drops, for example the application of steroids, are hampered by the effect of the eye to quickly drain off tears. There remains therefore a significant challenge in treating the above conditions safely, conveniently and cost-effectively.
Dexpanthenol is known as a B vitamin having a preservative effect but not as a treatment for contact lens papillary conjunctivitis and allergic eye disease.
US 2005/0164979 describes use of a composition containing a combination of panthenol or dexpanthenol and hyaluronic acid and/or hyaluronate for the treatment of various ophthalmological and rhinological malfunctions, including allergic rhinoconjunctivitis, atopic keratoconjunctivitis, allergic keratoconjunctavitis, gigantopapillary conjunctivitis, conjunctivitis vernalis, episcleritis such as for example episcleritis periodica, episcleritis partilis fugax, scleritis, tendonitis, Sjogren syndrome or hybrid forms thereof. It was found that the application of panthenol in combination with hyaluronic acid leads to rapid epithelialisation and therefore wound healing. Hyaluronic acid is described as playing a dual role in inflammation: it is both pro- and anti-inflammatory. It is pro-inflammatory in the initial phases promoting wound healing.
US 2007/0104744 describes a contact lens solution comprising a preservative enhancer (0.00001 to 10%) chosen from various B family vitamins together with the preservative to be enhanced, optionally with buffers and various other excipients. Dexpanthenol is one of the B vitamins described as enhancing the effect of the preservative in the solution.
WO 2010/056113 describes a combination of carnosine and dexpanthenol in a contact lens care solution. The solution is described as useful in preventing or treating corneal staining.
US 2007/0027048 describes a solution containing dexpanthenol for cleansing contact lenses and stabilising the lachrymal film.
Reference to any prior art in the specification is not, and should not be taken as, an acknowledgment or any form of suggestion that this prior art forms part of the common general knowledge in Australia or any other jurisdiction or that this prior art could reasonably be expected to be ascertained, understood and regarded as relevant by a person skilled in the art.